Provider Demographics
NPI:1477902112
Name:WONG, KIN CHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIN CHO
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOHNSON
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:223 N ELECTRIC AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-1929
Mailing Address - Country:US
Mailing Address - Phone:626-300-8223
Mailing Address - Fax:
Practice Address - Street 1:1041 E YORBA LINDA BLVD STE 206
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3763
Practice Address - Country:US
Practice Address - Phone:714-528-8252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1024611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program